What to do if you get worse while waiting for a heart assessment or procedure

With  so many NHS Trusts seeing a year on year increase in workload without additional resources many outpatient departments struggle to deliver satisfactory turnaround times for ‘urgent cases’. This fact is contributing to the massive rise in attendances in A&E.  In this short blog I have set out a few principles that may help patients waiting for care.

Heart Symptoms requiring emergency care ('999' callout)

  1. Any collapse other than can be explained by a drop in blood pressure caused by excessive GTN sublingually, standing up too quickly or a simple  faint in somebody who has a history of similar faints.
  2. Unexplained chest or upper back pains (with or without radiation to arm, neck) occurring at rest lasting more than 10 minutes, not resolved  by 1 puff of GTN spray or sublingual GTN tablet.
  3. Sudden onset unexplained breathlessness > 10 min that occurs at rest or when lying flat
  4. Very fast heart rates (over 150 beats per min)  that dose not resolve on resting
  5. Very slow heart rates (under 35 beats per min if taking a betablocker, under 45 bpm if NOT taking a Betablocker)

Heart Symptoms that should be notified to your GP or Hospital team (if contactable)

  1. Worsening angina or chest discomfort- for example  the distance walked before symptoms come on has shortened. Rapid access chest pain clinic for a Stress ECG and Cardiac CT has now revolutionised our triage of such symptoms.
  2. Worsening breathlessness on activity or lying flat or increasing ankle swelling that cannot be explained by a recent change in medication. Your GP should be able to assess whether immediate admission is required or run simple tests such as BNP, Chest X-Ray and or an Echocardiogram to diagnose any heart problems.

How to contact your team

Many NHS offices are understaffed and phone systems struggle to cope with the increasing demand so trying to notify by phone call to the hospital can be a frustrating experience. 

Alternative methods of getting in touch are:

  • Contact your GP who may be able to write to or email the Consultant
  • If you have access to a specialist Nurse (eg  heart  failure nurse)  call them for advice.
  • An email to a team member – remembering  that NHS staff are not allowed to use email containing any patient identifiers so may not be able to fully respond by email.  In addition incoming emails must be printed out and placed in clinical record before being replied to by clinical staff. This can take extra time to arrange, unless an electronic record system is being used.
  • Contact the PALS team at the hospital who can take up your query with the appropriate person.
  • Write to your consultant direct, we look at all incoming post.

Many clinicians are looking into alternative ways of communicating with their patients and it is hoped that successful pilot schemes run in our area in 2015 will lead on to more effective telephone and e-consultation triage systems.

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Edward Leatham is a Consultant Cardiologist in Surrey and a Trustee of Haste and Haste Academy.

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